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Z4, <br /> ------------------------------ <br /> -- --- ---- ---- --- <br /> -------------------------------- ---------- ---- -------- APPLICATION FM VANITATION PERMIT Permit No. <br /> --------- <br /> ------- -- --- <br /> ------------------------------------ --------- ---------- {Complefe in Duplicate} <br /> - ------------- ------------------ i <br /> This Permit Ex Dires I Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health DisfriCtr for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. <br /> 1.& <br /> JOB ADDRESS AND LOCATON----­ ------- <br /> - <br /> -2 -------- <br /> 0 <br /> Owner's Name-------;7;7 ---------------4--- <br /> Address---- 'r--- --------------I-------------------------------- -----­ Phor <br /> -,Ole/—--------------- <br /> -------------- ------ <br /> ------------- --- ----------------- <br /> Contractor's Nam gZ::- --------- ---- -- -- ---- --------- - tx Phone-4.-i�.e4i- ffW--- <br /> ------ --------4--- ----------- .... ------------ <br /> Installation will serve: Residence Apartment House El Commercial <br /> -7>Apart, railer Court 0 Motel E3 Other <br /> 0 ­.�❑14 <br /> Number of living units: Ger of bedrooms 0 D4 <br /> Number of baths size' <br /> Wafer Supply: Public system %ovir— <br /> �Commlunify system 0 Private E] Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand Ej Gravel ❑ Sandy Loam E] Clay Loa k m E] Clay E3 Adobe2­q�ardoan <br /> Previous Application Made: (If yes,date-__________________) No El New Construction: Yes El No <br /> FHA/VA: Yes El No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: I I <br /> * <br /> (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) <br /> Septic Tank: Distance fromfie'ar4st`W611------ Distance f r=m foundation__-.... ---------- --------------- <br /> E] N I ---------------- <br /> 0. of compartments..- -------------Size Liquid depth---------------- Capacity-. <br /> I w------------------------------- ------ --- <br /> Disp I Field: Distance from nearest well-& <br /> istance from foundati�Zon -..-dqDisfiance <br /> to nearest lot line..._.._._-- <br /> Number of lines-1-LA------ Length of eacF Width of trenc��!--62 !r, <br /> Ty <br /> r 1�,*--- Len <br /> of filter material/Ar-�Lj lengTh- Tj7/- --------i <br /> Pe of filter --- <br /> Se <br /> f k <br /> e Pit: Distance to nearest well W1,4­- <br /> ------------ <br /> I <br /> �ZA Number of pits-_f_.._ _._ .--------ww--- -------Distance from foundation--- ------------.D to nearest lot line ---------- <br /> Lining maferial-R-C,-A <br /> ------- -------S�ze: <br /> ,Diameter...... Deptk.-,-------- ------------ <br /> f well <br /> Cesspool: Distance from ne'ares' --------------.--Distance from' foundation--- ---------- material--'---- <br /> ❑ Sizea: Diameter-----I­'-" Depth--------------------------------------- <br /> -------------------------- <br /> --------------- Dept h---------w----------------------------- ----------Liquid Capacity-., ----------­I 7gals. <br /> Privy: <br /> Distance fr-orr)'nearest well--------------------*�, � "-�'- �D;sfance from nearest building------- -------------- i <br /> --------- <br /> Distance to nearerfine___________________"___- <br /> -------------------- <br /> - --------------- <br /> st lot iine-- ------------ <br /> Remodeling and/or repairing {describe):...._....._."._ <br /> %,----- -------- -------- <br /> --------------------------------- ---- ---------------- :Z <br /> - --------- - --- - - ------ --- <br /> o <br /> --------- -—-------- --------- <br /> -------------------------------------------------------------- ----------------- <br /> i---------------*---------------------------------------- <br /> --------------------------- -------------------m---W----1 0 - ----m-------- ----- ----------- ---- --- <br /> i ------------------ --------------------------------------------------- --------- I <br /> --------------------W---------- -------L ---------- <br /> ­Z­ i--- --- ------------------------------------------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with-San Joaquin Co'unfy <br /> ordinances, State laws,fa regulations on Joaquin Nuules and ltif r -uin 1­6cal Health IDisf ricf. <br /> (Signed). <br /> -------------- <br /> ---------- <br /> ---------- ........!,q---- <br /> SEPTIC ------------------- ---- ---- -------------------------------- ..40W7Zr-dnVV-ar Confracto <br /> TANK SERVICE r) <br /> By:----?.91,5-E.-bALo--r EZ I I <br /> ---------------- - -----VX91 (Title}----- ------------- --- <br /> - ---------fc:. .......Tit placed <br /> ----Y�u -------------- .......... - -----1. - <br /> (Plot plan, showing size of lot, location'of system i anon IIs, bu* ings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY...-. -. <br /> REVIEWEDBY----- --------------------------------------------------- DATE.------ -----------------I ------ <br /> BUILDING PERMIT ISSUED------------------------- ------------------------------------------------------ DATE---------------------------------------- ----------------- <br /> �r ----------------- ---- ------------------------------- ------------ DATE <br /> Alterations and/or recommenclaf ions:-J." <br /> ---------------------- <br /> ------------------------------------------------- -------- V.'616-4,1..... ----------------------------- -------------------------- <br /> 7 ------ . I - ---------------------------- -----------------------­- <br /> ------------------------------------------------- ------ ­ ­�- -1-- -44*v I <br /> ------------------- --------------------------------------------------------- - --------------- ........ <br /> ----------- ......------------------------------- I - -------- <br /> - ------------ ----------- -- --- <br /> ------iz�------ - --- ------ ---- <br /> ---- ........ <br /> - - ------- ---------------------------- --------------- ------ - -- ---- ------------- --- <br /> FINAL INSPECTION BY:......- Date. <br /> -------------- ----------- ------------ - <br /> S QUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Waxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street <br /> Stockton,California Lodi,California Manteca,California <br /> Tracy,Californiae' <br />